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* Rep. Greg Harris posted a list of just about every possible Medicaid cut on his Facebook page the other day. What I’ve done here is taken the most expensive “optional” Medicaid program and am asking which of these you would eliminate.

Remember, Medicaid must be trimmed by $2.7 billion. Optional services total about $2 billion. The items below total about $1.8 billion. Keep in mind these are services offered to real live human beings that we’re talking about here. Also, after you make your cuts (as many as you want), explain your reasoning in comments. The option to send nursing home residents to supported living facilities is a savings, not a cut, obviously. But keep that in mind when voting on the supported living facilities line. Thanks.

Online Surveys & Market Research

posted by Rich Miller
Wednesday, Mar 7, 12 @ 11:44 am

Comments

we [icked almost everything, but our favorite is the durable med equip which we think are those fancy electric scooter chairs that allow the obese to zip to the donut shop
We believe if cut all the faith based operations and whack jobs will provide free service

Comment by CircularFiringSquad Wednesday, Mar 7, 12 @ 11:58 am
I voted to cut the Supported Living Facilities because I don’t know what that is so the value is less clear to me than the other things. Is that group homes for the disabled or is this something for seniors in nursing homes too?

I guess it’s also because I have a more favorable opinion of nursing homes than other people do because my grandma got decent care from hers in the last years of her life.

As for the “fancy scooters” that CFS mentioned, don’t you remember the political fallout when Blagojevich tried to take away that one guy’s scooter in Southern Illinois?

Comment by hisgirlfriday Wednesday, Mar 7, 12 @ 12:10 pm
Rep. Harris’ Facebook list appears to omit some important alternative options. A major one I don’t see is reducing the number of Medicaid enrollees. There are multiple ways of doing so, and multiple additional choices.

We do ourselves a disservice by neglecting the fact our options are not limited to just these few.

That said, I give him immense credit for tackling this issue directly and leading on this difficult issue.

Comment by Shock & Awww(e) Wednesday, Mar 7, 12 @ 12:11 pm
===A major one I don’t see is reducing the number of Medicaid enrollees.===

Then you didn’t look nearly hard enough. I mean, it’s right at the top: “Eligibility Cuts.”

Comment by Rich Miller Wednesday, Mar 7, 12 @ 12:14 pm
I choose none of the above.

When you have billions of dollars to spend, these programs should be dictating what they are going to pay the healthcare providers and drug companies not what the taxpayer cuts are going to be.

Things like the negotiation of bulk drug purchases are barred and the re-importation of prescription drugs are barred to enhance corporate profits as the lobbyist request and then we are preached to about the so-called “free-markets” and the taxpayers are handed the bill.

That’s outrageous.

Yeah, I know the difference between the two programs and my example relates to prescription drugs. Nevertheless its a mindset that is embedded into both of these programs.

The solution is ALWAYS presented as either higher taxes or service cuts to the taxpayers.

How about competitive bidding and/or take it or leave it program for the corporations profiting from healthcare. I doubt very much that they would walk away from a billion dollar revenue stream. The way we have this system set up it’s just another back-door subsidy for the pharmaceuticals who are we kidding?

Comment by Oz Wednesday, Mar 7, 12 @ 12:14 pm
And we’ll be getting into those tomorrow.

Comment by Rich Miller Wednesday, Mar 7, 12 @ 12:14 pm
I picked everything but Mental Deisease. Those are the neediest of the topics listed and government should provide for the neediest. Everything else, while well intended, makes someone’s cousin wealthy at the expense of Illinois taxpayers.

Comment by Not for Nuttin' Wednesday, Mar 7, 12 @ 12:15 pm
Rich with the instant reply, before I even caught my error. Should switch your handle to “The Flash”. Gracias.

Comment by Shock & Awww(e) Wednesday, Mar 7, 12 @ 12:21 pm
The question illustrates the difficult decisions that the GA has to face. I and applaud them as they take on this difficult task.

As I thought about each item I wanted a different option. ( Before I write this I have to qualify that I do understand that there isn’t time in one day or space on this blog for the option I want, however….) The option I would like is to go through each of these and not cut the whole program but reduce it.

Example; move nursing home patients to assisted living. Those that can survive in an assisted living should be moved, but to say across the board that all can be moved is not reality.

Also, the Durable Medical Equipment is an item that I would cut except for those who are getting items they can’t live without. Hospital beds are a real necessity to some but a luxury for others. Scooter chairs are borderline, yet walkers for some are not.

Adult pharmacueticals, especially for those on drug rehab where they are on disability because they are an addict should be cut completely. But meds for those who need them or they will die should not be cut.
Group psychotherapy for nursing home residents should be cut unless there is a clear goal that can be met that would markedly improve those folks lives and make the home safer to others.

Before any of these cuts are made the private and not for profit providers should be paid in full and any further Medicaid payments made on time. The state cannot expect to turn over more patients to private providers and expect them to carry the cost.

One other item I would cut would be all dental, eyeglass, and medical to inmates unless they can pay for it themselves. I know this wasn’t on the list but to me it is related. If we can’t pay for hospice care for the terminally ill why are we giving care to people who break the law and should have very few rights.

Comment by Irish Wednesday, Mar 7, 12 @ 12:33 pm
Rich, I don’t know if it is at my end or what but my list doesn’t include “Eligibility Cuts.” It also doesn’t include the bar where you click to vote. My list starts with Hospice and ends with Institutes for Mental Disease.

Comment by Irish Wednesday, Mar 7, 12 @ 12:38 pm
–”Then you didn’t look nearly hard enough. I mean, it’s right at the top: “Eligibility Cuts.”

Maybe I’m seeing or shortened poll and/or need to put my eye glasses on (instead of their usual place of holding my hair back on top of my head)…but I don’t see eligibility cuts either.

Eligibility would have been my selection. I know it can’t be a matter of just household income though…and will not be enough, but I think once some of the use and abuse practices are found and trimmed there would be a better idea as to what more and to what extent needs to be next.

Comment by Cindy Lou Wednesday, Mar 7, 12 @ 12:41 pm
I’ll echo Irish’s comment: neither “Eligibility Cuts” nor the voting bar are visible to me.

Comment by Southern Anon Wednesday, Mar 7, 12 @ 12:42 pm
I agree with Oz.

Americans spend way too much for health care when compared to other nations. Not enough collective negotiating is one reason, but the main reason: applaud all you want Irish, but the foxes run the chicken coop.

http://www.washingtonpost.com/blogs/ezra-klein/post/why-an-mri-costs-1080-in-america-and-280-in-france/2011/08/25/gIQAVHztoR_blog.html

Comment by Blinkin' Fee: $20 Wednesday, Mar 7, 12 @ 12:46 pm
Here is a link to the entire list of potential cuts proposed to us by the Department of Healthcare and Family Services:

http://www.gregharris.org/wp/2012/03/01/help-choose-the-medicaid-cuts/

Comment by Rep, Greg Harris Wednesday, Mar 7, 12 @ 12:48 pm
- I’ll echo Irish’s comment: neither “Eligibility Cuts” nor the voting bar are visible to me. -

Me too.

Comment by Small Town Liberal Wednesday, Mar 7, 12 @ 12:51 pm
I also clicked on almost everything. Not because I wanted to, but because the numbers just don’t work otherwise. But knowing people who are going to have their lives thrown into complete chaos by these necessary cuts makes it almost unbearable.

I want to throw another completely different set of cuts out there. State revenue sharing with units of local governments (counties and municipalities) for both the state sales tax and state income tax needs to be cut by 50% minimum, starting next fiscal year.

Don’t like it, but if it’s the local governments or the service providers, well, we’ve got to take care of the service providers first.

We just don’t have any other options.

Comment by Judgment Day Wednesday, Mar 7, 12 @ 12:54 pm
I would like to see emergency room visists reviewed for actual emergent situations. I would estimate 60-70 per cent could be seen at an overnight promt care and/or seen the following day by the primary care. How many millions could this save the taxpayer each fiscal year. I would propose that all emergency room visits need primary care referral, if not an emergency situation. Let’s put responsibility and procedures in place to curb this abuse. Control thge access to those who are most in need!
Concerned Taxpayer

Comment by Anonymous Wednesday, Mar 7, 12 @ 12:58 pm
The Eligibility Cuts is on Rep. Harris’ FB page. Follow the link Rich provided to see the entire post. Rich just took an example, in this case actual cuts to services, to make people think about one aspect of the decision-making that must be made.

Comment by Demoralized Wednesday, Mar 7, 12 @ 1:02 pm
If we need to cut $2.7 billion and those total $1.8 billion, it would appear that we need to cut them all, and then some additional stuff too

Comment by titan Wednesday, Mar 7, 12 @ 1:03 pm
Anon @12:58:

That is a good idea that everybody has had. How do you enforce it? An emergency room cannot turn somebody away. It’s against the law.

Comment by Demoralized Wednesday, Mar 7, 12 @ 1:03 pm
PS. Eligibility cuts didn’t appear as a choice for me either.

Comment by titan Wednesday, Mar 7, 12 @ 1:04 pm
Emergency Rooms can refer patients after a brief evaluation to varying levels of care based upon presenting problem(s). What about promt care units being adjacent to the emergency rooms. The initial assessment would direct the patient upon registering. No one is denied, but appropriate level of care provided in the most effective and efficient manner possible.
Concerned T.P.

Comment by Anonymous Wednesday, Mar 7, 12 @ 1:15 pm
Anonymous: You’re assuming everyone has access to a prompt care facility. South of I80, that’s not always the case without a 45-75 minute drive, compared to 15-20 for a hospital ER. I’m not disagreeing that there is probably profit padding in the ER visits, just that there is no planned network of prompt care facilities based on patients served. They open where they are profitable, which means where they have the population base to make sure the money keeps flowing.

Comment by Colossus Wednesday, Mar 7, 12 @ 1:23 pm
For the record: I voted to move nursing home residentes to supportive care.

I fully admit that I ruled out anything related to mental health as something I could vote for. Having tried to get someone help through Medicaid mental health services, it is simply unconscionable to cut any more from this area.

As it comes up in every conversation here, there HAVE been cuts to many government programs in the last ten years. There comes a time where you have to admit that you have cut something as far as it can go and look somewhere else.

I’m also glad to see that Adult Rehab is one of the lower categories here. Much more cost effective than throwing those patients into DOC. Having known folks who have gone through Medicaid rehab, it seems that those programs are surprisingly effective.

Comment by Colossus Wednesday, Mar 7, 12 @ 1:28 pm
Is there an incentive for Hospitals to have a 24 hr. clinic that would take patients that don’t really need emergency room level care? Maybe reimburse at a higher level than the ER. Many medicaid people don’t have a primary care doc because the docs don’t take Medicaid. So when they get something that requires a drs visit they go to the emergency room. Many timwes they have let something go too long that could have been taken care of earlier for less. This would also free up room in the ER.

I took my wife to the emergency room just before Christmas, she was pretty sick. She had been treating with our doc but it got worse over a weekend. She was admitted with pneumonia. While we were in the ER the ER rooms filled up with folks that had colds, had gotten in a fight, and were in a minor accident. From what I heard, without really trying, most did not have insurance, a couple walked out in the midst of treatment. All I could think was what would have happened if there had been several legitimate ER patients brought in and what that whole evening was costing the hospital and us.

Comment by Irish Wednesday, Mar 7, 12 @ 1:33 pm
As you are voting, remember that taxpayers are real human beings, also, Rich. Many of them make less money per year than some of the people on the Medicaid program.

Comment by Old Milwaukee Wednesday, Mar 7, 12 @ 1:36 pm
–”The Eligibility Cuts is on Rep. Harris’ FB page. Follow the link Rich provided to see the entire post. Rich just took an example, in this case actual cuts to services, to make people think about one aspect of the decision-making that must be made.”–

Ok, then if cutting who qualifies is already considered top of the list, then I guess my next thoughts are not perhaps to totally cross off any/all of the polls selections. Instead go through the amounts of the service (meaning to what extent they will pay for an individual part of the selection) and requirements to get the selection.

I’m not ready to just cross off an entire program expense, without carefully looking at who gets it, why and to what extent. Perhaps after seeing what trimming and updating the who and how and what exactly in detailed changes and saving it would bring, I’d be ready to focus more than on what really has to ‘go’.

Comment by Cindy Lou Wednesday, Mar 7, 12 @ 1:43 pm
The box isn’t working as intended, as others have said — so I’ll just thank Greg Harris for being so helpfully transparant.

Comment by mark walker Wednesday, Mar 7, 12 @ 1:48 pm
Mine has 10 entries starting with Hospice and ending with Institutes for Mental Disease

Comment by Lucky than Good Wednesday, Mar 7, 12 @ 1:59 pm
How do you monitor ER visits as to what is or is not an emergency? How do you tell someone they can wait and see their primary care MD the next day when they don’t have an MD because they have no insurance?

Comment by Anonymous Wednesday, Mar 7, 12 @ 2:02 pm
Anon:

I’m not arguing with you. I just don’t know how you make it work. I’m not in health care so I don’t know how billing works, but maybe you do it by forcing hospitals who see Medicaid patients in the emergency room to bill by specific codes based on the problem. So it wouldn’t simply be billed as an ER visit but maybe as simply a Dr. visit.

Comment by Demoralized Wednesday, Mar 7, 12 @ 2:04 pm
The choice of what will ultimately be cut will rest with those contributing the most to the politician, and those companies with the most to gain or lose.

Because we the people may find it very difficult, those voting will take away our burden of difficult choices and make it on our behalf….as long as they and their contributors benefit.

Health care is the 800 pound gorilla in the room and will just keep getting bigger and bigger as our population ages and our youth are indoctrinated into thinking they are getting something for ’seemingly’ nothing.

As I see it, we are fast heading toward a national health care plan via an eventual Public Option. It may be the only way to drive down costs and help the helpless politicians to vote in favor of the people they serve, as opposed to the businesses that contribute to them.

Comment by Sunshine Wednesday, Mar 7, 12 @ 2:06 pm
I selected all. Terrible choices of course, but we have no choice. The short sighted decisions of the past legislatures and governors have put us here. Quinn is right, we must have a reality check and as painful as it is - we have no choice. These cuts are absolutely necessary.

Comment by Siriusly Wednesday, Mar 7, 12 @ 2:10 pm
Yeah, I voted to cut $1 billion even.

Here’s another option no one is talking about: COBRA.

Currently, private health insurance companies have no financial incentive to prevent illnesses or chronic diseases that occur after people retire.

The relatively small cost of preventing osteoporosis is something they ignore because people don’t fall and break their hip and end up in a nursing home until they are over 65 and on the government’s dime.

It’s called soft-budgeting. Its what leads to central government bailouts of mismanaged states in the third world, and in the U.S. its resulted in a federal government subsidy for care that insurance companies ought to have been providing to their patients.

If someone has insurance when they get pregnant but then loses their job and their insurance coverage, why should Medicaid foot 100% of the bill?

We need a mechanism like COBRA to ensure that insurance companies and not the taxpayers are responsible for expenses like these.

Comment by Yellow Dog Democrat Wednesday, Mar 7, 12 @ 2:14 pm
Kinda funny how we are willing to talk about real cuts to services to save money rather than eliminating or reducing things that drive up the costs such as medical malpractice, over-testing (partially attributable to malpractice costs), unnecessary ER visits, harsher fraud penalties, etc.

Comment by Shemp Wednesday, Mar 7, 12 @ 2:19 pm
Let’s be creative! Springfield and surrounding areas are blessed with Promt Cares. The problem is they don’t seem to be open after 10 p.m. Why not hve HFS develop pilot sites and see if their are viable solutions, through improved access through overnight treatment options. Increase the Public Aid rate for Dr. visits and maybe we would see Primary Care used rather than Emergency Room Care.
Concerned T.P.

Comment by Anonymous Wednesday, Mar 7, 12 @ 2:21 pm
I didn’t pick any, because it’s too horrible and I don’t have to. Just one thing — If we get rid of hospice care, don’t those folks end up staying in the hospital, which costs way more?

Comment by soccermom Wednesday, Mar 7, 12 @ 2:24 pm
In his budget address Governor Quinn said more than half the babies born today are covered by Medicaid. Seems to me we need that number to be 1 in 10 for starters.

Comment by Jaded Wednesday, Mar 7, 12 @ 2:27 pm
== the number of babies covered by Medicaid should be 1 in 10 instead of 1 in 2. ==
That 50%+ number reflects who is having babies, and the growth of families in poverty.

Telling indigent pregnant women they and their babies are out of luck for medical care doesn’t strike me as the pro-life thing to do.

Comment by reformer Wednesday, Mar 7, 12 @ 2:38 pm
1) This is a great idea for a poll, Rich. It is real easy to say “cut medicaid!” since poor folks don’t have much of a lobby. Real tough when you have to pick actual cuts.

2) Given the state budget, I do believe actual cuts need to be made here and voted for the two mental illness options (”Group Psychotherapy in Nursing Home” and “Institutes for Mental Disease” and the dental option. Tough choices, as I just probably increased the homeless population and probably contributed to the prison population by shutting down mental disease institutes. But given the state of the state’s budget, that’s my vote. Anyway, just over $190 million in cuts.

3) “Send nursing home patients to supportive living facilities” is a big number and is tempting, but my limited understanding of supportive living facilities is that they don’t provide the care that folks in nursing homes need.

4) This is always a site with intelligent, knowledgeable commenters - I’m a tad disappointed today that so few commenters played along and explained their cuts.

5) re: eligibility cuts, of course that would have been easy to vote for in theory, but I think we need to know who we’re cutting, what income level/family size, before we hop on that train.

Comment by Robert Wednesday, Mar 7, 12 @ 2:39 pm
Would that it was as simple as checking services off a list. There are comments about not covering wheelchairs or scooters. Right now, there is a man in my town who has no legs. He uses a scooter to get around. Literally. He rides it by my house to go to church across the street. He uses it to go to the store to pick up groceries. He rides it to doctor appointments in town. His freedom to go anywhere is dependent on that scooter. It allows him to live fairly independently.

He has been told that medicaid isn’t going to pay for it and it costs $8000. I don’t know specifics of how he got the scooter and how he was approved to receive it by the company that provided it.

If he has to return the scooter, he is no longer able to get where he needs or wants to go without help from somebody else. The man was on local tv, in tears over what he is going to lose in the way of freedom and independence. He is terrified that he will have to move into some form of living center - which would certainly cost the state far more than an $8000 scooter.

There is a human price to pay for each of these things we forfeit. Yes, maybe his church or people in town can raise some money to pay for his electric scooter. But, churches and spaghetti dinners cannot make up for the hundreds of millions of dollars that will be cut from the state budget.

The state will do what it has to do to fix the train wreck that is our state budget. Just remember that there will be a human price to pay.

Comment by Aldyth Wednesday, Mar 7, 12 @ 2:57 pm
None of the above and all of the above. Health Care reform will have to occur and changes will need to be made. Costs for health care in the USA are higher then almost anywhere else in the world - significantly so, yet our outcomes are no better and often worse. Prevention services, intervention services need to be increased ASAP - many of these were not paid by private insurance for decades, or the co-pays were so high, we now have some of the results. Care needs to take place in the least restrictive/costly but effective setting as possible. Medical appliances that allow someone to remain in the home, as well as home health aids need to be increased - even if then are the electric chairs - this is better then placeing one in a care setting. Drug costs needs to be contained - I have private insurance - yet my copays are $400 per month - this takes everything. There is no easy or simple solution, it is not just medicaid - however - maybe there should be some co-pays for education. We however have to acknowledge that like we have food desserts - we also have primary care ones - we have somewhat of a shortage - and in some areas it is more than somewhat - not just urban - but southern Illinois. The quick first step - a percentage of everything - then an honest evaluation and building process. If I had my wish - health insurance would be non-profit!

Comment by sadie Wednesday, Mar 7, 12 @ 2:58 pm
The real issue is the escalating cost of healthcare. Let’s face it, none of us look forward to dying. Technology continues to improve healthcare services but at a cost that will not keep up with our ability to pay in our current economic environment. These same pressures are driving up insurance costs for employers and forcing them to provide insurance plans that require more from the employee.

Comment by Stateline Wednesday, Mar 7, 12 @ 3:07 pm
=Telling indigent pregnant women they and their babies are out of luck for medical care doesn’t strike me as the pro-life thing to do.=

Who said I was pro life?

I don’t think you are saying that, but maybe people on Medicaid are having babies because they are on Medicaid and get more money when they have babies. Nah, that is just some right wing craziness I shouldn’t be repeating.

Comment by Jaded Wednesday, Mar 7, 12 @ 3:39 pm
People, don’t be so dense. Eligibility choices are on Harris’ FB page. We’ll get to them tomorrow.

Comment by Rich Miller Wednesday, Mar 7, 12 @ 3:39 pm
- In his budget address Governor Quinn said more than half the babies born today are covered by Medicaid. Seems to me we need that number to be 1 in 10 for starters. -

So you’re for providing comprehensive family planning options as well as a robust sex education program? And you’re for a more progressive tax system that helps more families work their way to the middle class? Cool, count me in.

Comment by Small Town Liberal Wednesday, Mar 7, 12 @ 3:42 pm
@Shremp -

Lawsuits SAVE Medicaid money.

If someone is injured and ends up needing Medicaid as a result, Medicaid is the first one paid out of any jury award or settlement.

Comment by Yellow Dog Democrat Wednesday, Mar 7, 12 @ 4:42 pm
=So you’re for providing comprehensive family planning options as well as a robust sex education program? And you’re for a more progressive tax system that helps more families work their way to the middle class? Cool, count me in.=

Wow I can’t believe we actually agree on something. I’m also in favor of personal responsibility. Are you good with that too?

Comment by Jaded Wednesday, Mar 7, 12 @ 4:55 pm
The survey is ridiculous, given that all of the “options” are penny-wise and pound-foolish — elimination will simply shift cost to other, probably more expensive services. There can probably be upper limits on coverage, or payments, but not elimination. Loss of Federal Financial Participation by cuts compounds the impact. Considering historical FFP, consideration should be given to “capping” GRF expenses in the future when the 100% FFP for expansion decreases to 90%.

Comment by ANAL Wednesday, Mar 7, 12 @ 5:01 pm
good idea to ask us, but the list is so incomplete that answering feels wrong. Irish is correct about the eligibility issue.

Comment by amalia Wednesday, Mar 7, 12 @ 5:09 pm
And dental may seem like a frill. But having missing teeth is a huge issue for people who are looking for work; would you hire a receptionist missing four of her front teeth? And dental problems have increasingly been linked to very expensive health problems in the rest of the body. Again, penny wise, pound foolish.

Comment by soccermom Wednesday, Mar 7, 12 @ 5:16 pm
@Yellowdog — How many Americans going through a job loss can afford COBRA premiums, assuming they were even covered by health insurance by their former employer?

COBRA might work for those who wouldl be fine regardless of their employment status, but I don’t see it as a solution for anyone else.

Comment by Blinkin' Fee: $20 Wednesday, Mar 7, 12 @ 5:37 pm
Is there a do nothing until after the election option. If so, I think that is where we are headed. I just don’t see a majority legislators, even after the primary, voting to cut more than a token amount of this stuff. Then we’ll be in 2013, so close to the implementation of the Affordable Care Act that any changes in benefits and eligibility will necessarily be folded into the discussion of implementation of ACA.

Comment by cassandra Wednesday, Mar 7, 12 @ 6:04 pm
@Blinkin -

Sorry, let me clarify. I’m not suggesting that people should actually have to buy additional coverage.

I’m suggesting that if someone seeks medical care through Medicaid for a condition that arose while they were on private pay insurance, that private insurance company should have to pick up the tab for the pre-existing condition, not Medicaid.

Think of it as a tail policy.

Comment by Yellow Dog Democrat Wednesday, Mar 7, 12 @ 7:06 pm
all of the above. The state budget has become dominated by health care expenditures. gotta end.

Comment by park Wednesday, Mar 7, 12 @ 8:10 pm
If the state currently leaves people eligible for Medicaid up to 200% of poverty & the federal Affordable Care Act uses 133% of poverty as the minimum level for Medicaid once effective, it’s worth asking how much would be saved if the state switched from 200% to 133%.

Comment by RFL Wednesday, Mar 7, 12 @ 9:17 pm
” faith based operations and whack jobs”

But I repeat myself.

Comment by wishbone Wednesday, Mar 7, 12 @ 10:51 pm